Immunology Flashcards
a. What muscles come from first arch?
b. what nerves come from first arch?
a. muscles of mastication, mylohyoid muscle, tensor tympani, tensor veli palatini
b. maxillary and mandibular division of trigeminal nerve
What amino acids are found in elastin?
Glycine and proline
What is mechanism of adenosine as anti-arrhythmic?
Increases outward K current
Hyper polarization of cells
Decreases intracellular Ca
What part of the body drains to:
a. Axillary lymph node
b. Superificial inguinal nodes
c. Popliteal nodes
a. Upper limb, breast, skin above umbilicus
b. anal canal (below pectinate line), skin below umbilicus, scrotum
c. Dorsolateral foot, posterior calf
Which part of the GI tract drains to:
a. Celiac lymph nodes
b. Superior mesenteric nodes
c. Inferior mesenteric nodes
d. Internal iliac nodes
a. liver, stomach, spleen, pancreas, upper duodenum
b. lower duodenum, jejunum, ileum, colon to splenic flexure
c. colon from splenic flexure to upper rectum
d. lower rectum to anal canal (above pectinate line), bladder, vagina, prostate
Which lymph nodes do the testes drain to? the scrotum?
Testes –> PARA-AORTIC
Scrotum –> superficial inguinal
What part of the body does the right lymphatic duct drain?
Right side of body above the diaphragm
What part of the body does the thoracic duct drain?
Everything else besides right side of body above diaphragm. Goes into junction of left subclavian and internal jugular veins.
Where do you find peer’s patches?
In lamina propria submucosa of ileum
a. What muscles are derived from second branchial arch?
b. nerves from second branchial arch?
a. Muscles of facial expression, stapedius, stylohyoid
b. Cranial nerve seven
Which cells express MHCI?
ALL cells EXCEPT RBCs
a. What genes code for MHC I?
b. What genes code for MHC II?
a. HLA-A, B and C
b. HLA-DR, DP, and DQ
What diseases does HLA-B27 predispose to?
PAIR Psoriatic arthritis Ankylosing spondylitis Inflammatory Bowel Disease Reactive arthritis
What diseases do HLADR3/4 predispose to?
Diabetes mellitus type I
DR4 - Rheumatoid arthritis
a. What is Langerhans Cell Histiocytosis?
b. What markers does it express?
c. ON electron microscopy?
d. How does it present?
a. Group of proliferative disorders of dendritic cells
b. Express S-100 and CD1a
c. Birbeck granules
d. Presents as child with lytic bone lesion and skin rash or recurrent otitis media with mass involving mastoid bone
What 4 things are expressed on dendritic cells?
B7
CD40
MHC I
MHC II
What mediates the following reactions:
a. hyperacute transplant rejection
b. acute transplant rejection
c. chronic rejection
d. graft vs. host
a. pre-existing recipient antibodies
b. T cells
c. T cells and Antibodies; Cytotoxic T cells treat transplant cells as self cells presenting non-self antigen - irreversible
d. Usually in BM transplants; the grafted immunocompetent T cells proliferate in the immunocompromised host and reject host cells with “foreign proteins”
How does graft vs. host disease present?
Maculopapular rash, jaundice
Diarrhea, hepatosplenomegaly
Cyclosporine
a. Mechanism
b. Uses
c. Adverse effects (unique one?)
a. Binds to cyclophilin –> inhibits Calcineurin –> prevents production of IL2 –> disrupts T cell activation
b. Prevent transplant rejection, psoriasis, RA
c. Viral infections, lymphomas, NEPHROTOXICITY, HTN
Tacrolimus
a. Mechanism
b. Uses
c. Adverse effects
a. Bind FK506 binding protein (FKBP) –> inhibits Calcineurin –> prevents production of IL2 –> blocks T cell activation
b. Transplant rejection prophylaxis
c. Increased risk of diabetes and neurotoxicity,, nephrotoxicity, HTN
Sirolimus
a. Mechanism
b. Uses
c. Adverse effects
a. binds FKBP –> inhibits mTOR –> inhibition of T cell proliferation and prevents response to IL2
b. Kidney transplant
c. Not that important - NOT NEPHROTOXIC; anemia, thrombocytopenia, leukopenia
Azathioprine
a. Mechanism
b. Use
c. Adverse effects
(precursor to 6-Mercaptopurine)
a. Inhibits lymphocyte proliferation by blocking nucleotide synthesis
b. Transplant rejection prophylaxis (especially kidney), RA, glomerulonephritis
c. BONE MARROW suppression; degraded by Xanthine Oxidase (toxic effects can be increased by Allopurinol)
Mycophenolate
a. Mechanism
b. Use
a. Inhibits IMP dehydrogenase –> prevents synthesis of guanine –> no cell replication/proliferation of B cells and T cells
b. Transplant patients and Lupus nephritis
Muromonab
a. Mechanism
b. Use
a. Binds CD3 (T cells) –> interferes with T cell signal transduction –> shuts down T cells
b. Transplants
Daclizumab
a. Mechanism
b. Use
a. Binds to CD25 (IL2 receptor on activated T cells) –> blocks IL-2 signaling (Sirolimus is similar)
Thalidomide
a. mechanism
b. use
c. toxicity
a. affects TNFa
b. Immunosuppression, anti-angiogenic
c. NOT USED - phocomelia, teratogen
a. What are the anti-TNFa agents?
b. What are they used for?
c. Which anti-TNF alpha drug is not a monoclonal antibody?
a. Adalimumab, Infliximab
b. Ankylosing spondylitis, RA, IBD, reactive arthritis
c. Etanercept - mimics TNFa receptor (gobbles up TNFa in circulation)
Abciximab
a. Mechanism
b. Use
a. Targets platelet glycoproteins IIb/IIIa
b. Anti-platelet agent for prevention of ischemic complications in patients undergoing percutaneous coronary intervention
Trastuzumab (Herceptin)
a. Mechanism
b. Use
a. Ab against HER2
b. Breast cancer that expresses HER2
Rituximab
a. Mech
b. Use
a. Targets CD20
b. B cell NON-Hodgkin lymphoma
Omalizumab
a. Mech
b. Use
a. Targets IgE
b. Severe asthma
Bruton agammaglobulinemia
a. defect
b. presentation
c. findings
a. defect in BTK (tyrosine kinase gene) –> no B cell maturation; X linked recessive
b. Recurrent bacterial infections and enteroviral infections after 6 months (decreased maternal IgG)
c. Absent B cells in peripheral blood, decrease IgG of ALL classes; absent lymph nodes/tonsils
Selective Ig Deficiency
a. Defect
b. Presentation
c. Findings
a. Most common primary immunodeficiency; unknown
b. Majority asymptomatic, can see airway and GI infections; autoimmune disease (atopy, asthma) anaphylaxis to IgA products
c. Decreased IgA with normal IgG and IgM
Common Variable Immunodeficiency
a. Defect
b. Presentation
c. Findings
a. Defect in B cell differentiation
b. Can be acquired in 20-30s, increased risk of autoimmune disease, bronchiectasis, lymphoma, sinopulmonary infections
c. decreased plasma cells, decreased immunoglobulins
Thymic aplasia (DiGeorge)
a. defect
b. presentation
c. findings
a. 22q11 deletion; failure to develop 3rd and 4th pharyngeal pouches –> absent parathyroids and thymus
b. Cardiac abnormality, Abnormal facies, Thymic aplasia, Cleft palate, Hypocalcemia - recurrent viral, fungal and protozoal infections
c. Decreased T cells, PTH and Calcium; absent thyme shadow on CXR
IL-12 receptor deficiency
a. defect
b. presentation
c. findings
a. decreased TH1 response; AR
b. disseminated MYCOBACTERIAL and fungal infections;
c. Decreased IFNy
Chronic Mucocutaneous Candidiases
a. defect
b. presentation
c. findings
a. T cell dysfunction; many causes
b. non-invasive Candida albicans infections of skin and mucous membranes
c. absent cutaneous reaction and T cell proliferation in response to Candida antigens
Hyper IgM Syndrome
a. defect
b. presentation
c. findings
a. defective CD40L on Th cells –> defect in class switching; X linked recessive (3 types)
b. Severe pyogenic infections early in life; opportunistic infection with Penumocystis, Crypto, CMV
c. Increased IgM, decreased other antibodies
SCID
a. defect
b. presentation
c. findings
a. defect in early stem cell differentiation; caused by many including adenosine deaminase deficiency (X linked)
b. failure to thrive, chronic diarrhea, thrush, recurrent viral/bacterial/fungal/protozoal infections (treat with BM transplant)
c. Decreased T cell receptor excision circles (TRECs); absence of thymic shadow, germinal centers, and T cells
Wiskott-Aldrich Syndrome
a. defect
b. presentatin
c. findings
a. Mutation in WAS gene (X linked) –> T cells unable to recognize actin cytoskeleton
b. Thrombocytopenia purpura, Eczema (on trunk), Recurrent infections
c. Decreased to normal IgG, IgM; Increased IgE and IgA; fewer/smaller platelets
What are the X linked immunodeficiencies?
Wiskott Aldrich
Bruton Agammaglobulinemia
Chronic granulomatous disease
Hyper-IgM syndrome
Ataxia Telangiectasia
a. defect
b. presentation
c. findings
a. defects in ATM gene –> failure to repair DNA double strand breaks –> cell cycle arrest
b. Triad = Cerebellar defects (ATAXIA), spider Angiomas (telangiectasia) IgA deficiency
c. Increased AFP, decreased IgA, IgG an IgE; lymphopenia, cerebellar atrophy
Chronic Granulomatous Disease
a. defect
b. presentation
c. findings
a. defect in NADPH oxidase –> decreased reactive oxygen species and respiratory burst in neutrophils
b. Increased susceptibility to catalase + organisms (Nocardia, Pseudomonas, Listeria, Aspergillus, Candida, E. coli, S. aureus, Serratia
c. Abnormal dihydroorhodamine test; nitroblue tetrazolium dye reduction test is negative
How is CGD treated?
Prophylactic TMP-SMX
Chediak-Higashi Disease
a. defect
b. presentation
c. findings
a. defective LYST gene –> defective lysosomal transport –> microtubule dysfunction in pharosome-lysosome fusion (AR)
b. Recurrent pyogenic infections by Staph and Strep; partial albinism, peripheral neuropathy, progressive neurodegeneration, infiltrative lymphohistiocytosis
c. giant granules in granulocytes and platelets, pancytopenia, coagulation defects
Leukocyte adhesion deficiency type 1
a. defect
b. presentation
c. findings
a. defect in LFA-1 integrin (CD18) on phagocytes, impaired migration and chemotaxis (AR)
b. recurrent bacterial skin and mucosal infections, absent pus formation, impaired wound healing, delayed separation of umbilical cord
c. Increased neutrophils, absence of neutrophils at infection sites
What cytokines do T helper cells produce to stimulate B cells?
IL4, IL5
What are the surface markers of B cells?
CD19, CD20, CD21, IgM, IgD
What cell markers do T cells have?
CD3, CD28, T cell receptor
Cytotoxic T cells have CD8
Helper T cells have CD4 and CD40L
What cell markers do NK cells have?
CD56 and CD16
What cell markers do macrophages have?
CD14, MHC II, B7 protein, CD40
Which organism’s exotoxin works via each of the following mechanisms?
a. inactivates EF2
b. activates Gs
c. Disables Gi
d. Bacterial adenylat cyclase (No G protein involved)
e. Blocks GABA and glycine
a. Corynebacterium diptheriae, Pseudomonas (exotoxin A)
b. Vibrio cholerae, E. coli (ETEC heat labile toxin)
c. Pertussis toxin
d. Bacillus anthracis
e. Clostridium tetani (lockjaw)
What drug helps to make diagnosis of Myasthenia gravis?
Edrophonium (acetylcholinesterase inhibitor)
Too short acting to treat
What heart sound is associated with dilated CHF?
S3
What heart sound is associated with stiffened LV?
S4
What is amyloidosis?
Accumulation of one specific protein in the tissues that aggregates into B pleated sheets which causes damage and apoptosis
What is AL amyloidosis? What protein is deposited? Which organs does it affect?
(Primary)
Due to deposition of proteins from Ig Light chains
Can occurs as plasma cell disorder or associated with multiple myeloma.
Often affects multiple organ systems including renal (nephrotic syndrome), cardiac (restrictive CM, arrhythmia), hematologic (brushing, splenomegaly), GI (hepatomegaly) and neurologic (neuropathy)